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BMC Neurology

, 5:10

First Online: 10 June 2005Received: 24 January 2005Accepted: 10 June 2005

Abstract

BackgroundRecent trials suggest that angiotensin-converting enzyme inhibitors ACEI are effective in prevention of ischemic stroke, as measured by reduced stroke incidence. We aimed to compare stroke severity between stroke patients who were taking ACEI before their stroke onset and those who were not, to examine the effects of pretreatment with ACEI on ischemic stroke severity.

MethodsWe retrospectively studied 126 consecutive patients presenting within 24 hours of ischemic stroke onset, as confirmed by diffusion-weighted magnetic resonance imaging DWI. We calculated the NIHSS score at presentation, as the primary measure of clinical stroke severity, and categorized stroke severity as mild NIHSS less than or equal to 7, moderate NIHSS 8–13 or severe NIHSS greater than or equal to 14. We analyzed demographic data, risk-factor profile, blood pressure BP and medications on admissions, and determined stroke mechanism according to TOAST criteria. We also measured the volumes of admission diffusion- and perfusion-weighted DWI -PWI magnetic resonance imaging lesions, as a secondary measure of ischemic tissue volume. We compared these variables among patients on ACEI and those who were not.

ResultsThirty- three patients 26% were on ACE-inhibitors. The overall median baseline NIHSS score was 5.5 range 2–21 among ACEI-treated patients vs. 9 range 1–36 in non-ACEI patients p = 0.036. Patients on ACEI prior to their stroke had more mild and less severe strokes, and smaller DWI and PWI lesion volumes compared to non-ACEI treated patients. However, none of these differences were significant. Predictably, a higher percentage of patients on ACEI had a history of heart failure p = 0.03. Age, time-to-imaging or neurological evaluation, risk-factor profile, concomitant therapy with lipid lowering, other antihypertensives or antithrombotic agents, or admission BP were comparable between the two groups.

ConclusionOur results suggest that ACE-inhibitors may reduce the clinical severity of stroke, as measured by NIHSS score. Further, larger-scale, prospective studies areneeded to validate our findings, and to elucidate the mechanisms of ACEImediated benefits in patients with ischemic stroke.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2377-5-10 contains supplementary material, which is available to authorized users.

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Autor: Magdy Selim - Sean Savitz - Italo Linfante - Louis Caplan - Gottfried Schlaug

Fuente: https://link.springer.com/



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